HDR Brachytherapy Round 1 ->

Had my procedure at Emory-St. Joseph's at 7:30 a.m. this morning.

I'm feeling good right now, at 10 p.m., but for the board I wanted to give an account of my procedure:

Monday - liquid diet all day, plus a bottle of magnesium citrate in the afternoon and a fleet enema at 9 p.m. Nothing to drink or eat after midnight.

Tuesday. -Checked in at 5:30 a.m. Undressed all the way into a robe and wheeled to the pre surgery area for prep, IV, etc.

-Wheeled into the surgery room right on time. All I remember is talking to a couple of guys and then putting on the anesthesia mask.

- Woke up at some point with a catheter in and 16 needles that had been implanted through my scrotum and into my prostate. The pressure was pretty intense. The feeling of needing to urinate was strong.

- At some point I started getting some bladder spasms that hurt, like a 7 on a 10 scale.

- Went into a nice waiting room with a tv where I had some delicious saltine crackers and orange juice AND a perkiset.. (sp?).

- Rolled down to radiation, where the nurse and physicist made the plan, along with Dr. Rossi.

-The radiation machine was hooked up to the wires implanted in my scrotum. There was a piece sutured to my scrotum holding the needles. I felt some vibrating with the radiation but no pain.

- The pain at this point was all about the pressure from those needles and the catheter. It was getting fairly unbearable by the end of the 40 minutes of radiation.

- After finishing, the doctor said he was going to take the needles out. They got me to relax and he jerked the needles out fast and all at once. I believe this was the most intense pain I have ever felt in my 48 years. It was awful, and the nurse had to keep pressure on it for 10 minutes.

- When I settled down, the nurse took (jerked) the catheter out. This pain might make my top 10 all-time pain.

- On the way home I got a little sick and almost puked. It's an hour drive for me and my wife isn't the smoothest driver.

- I took a two hour nap and felt pretty fair afterwards. I went to a school board meeting (my term ends this month) and an office Christmas party. I actually felt very good from 8 pm on.

- when I urinate, it feels like pissing razor blades. Seems to be getting better, but the first three or four times to pee is awful.

I'm feeling good about my choice, but not looking forward to doing it all again Dec. 16.

My doctor said this would "do significant damage to the cancer cells" today, when I asked if it was killed over time sine they can't multiply.

Thanks for sharing. The procedure you described is nothing like what I thought it was.

Wow, doesn't sound like much fun. Did you have the button to push for pain meds. They had me hooked up to an IV from start to finish with a nice red button to push for pain meds, which made all the difference I guess.

They also gave me a prescription pill to prevent painful urination. I don't remember the name, but it turned my piss orange.

Glad you're on this side.

Thanks for the report.

Before you know it this will just be a bad memory.

Andrew

Glad you got the first one done.   Sorry about the pain and discomfort....that wasn't at all my experience.  

In my case, I had a spinal block (epidural) that took all pain and feeling away from my hips down for several hours.   I also was put under a mild anaesthesia during the catheter insertion for about 45 minutes.

I never had any pain or discomfort during the fine tuning of the catheters, the insertion of the radiation wire, and the removal of the template and 15 catheters an the Foley catheter.   Never felt a thing and had no pain or discomfort after the block wore off.   When they removed the sutures holding the catheters and template to the body and then pulled the catheters out in one pull I didn't even realize they had done it as I felt nothing.   Same with the removal of the Foley catheter.

Before your next procedure ask if you can have a spinal block.   The reason urinating was painful is that they probably didn't use a Foley catheter lubricant that had lidocaine to numb the uretha   If they do that, there should be no burning.

I had my procedure in the afternoon, so I went home afterwards and relaxed in the evening.   Back to work the next day and on the second day I was back in the gym.   

Yikes. Catheter gave me a hell of a pain too. Felt like a Roto-Rooter due to some odd bend the nurse told me about in my uretha.

I had the epidural when the implant was sutured on. To me the only significant brachy-related pain was when they removed the sutures and the the implant. I did have a ton of back pain from the limited mobility that was killing me and caused me to overdo it somewhat on the pain pump during my first session. I handled that much better the second time around.

I was also in overnight as they did the first fraction in the afternoon of day 1 and the second in morning of day 2. This was at UCLA. As I understand it, they do it all in one day now.

Dewayne: I'm glad you're rebounding so quickly, but there's nothing wrong with taking it easy for a day or two. It's not surgery, but it's still a major medical procedure so why not make things easier yourself? IMHO.

PS Perineum = area between scrotum and anus.

Wow - glad that wasn't my reaction.

Just finished 4 rounds of HDR - 16 needles and while not fun at all only had significant pain on the last one.

I didn't have a spinal BTW.

The first time that they took the catheter & needles out it hurt a bit but mostly because it was hard to relax when they told me to. The first few times I urinated it did feel like burning but that went away after a day.

The second time my only real problem was that they nicked my bladder and so I had a lot of clots that were not fun to pass for a few days.

Third time no problems.

Fourth - and thankfully last time - there was a bit of pain. It was the only time that I needed to take the codeine that they gave me an Rx for after the procedure.

Also, we were a 2 hour drive from the hospital and so had to stay at a hotel the night before and the night of the procedures and then a long drive afterwards. Found that a hemorrhoid ring and frozen peas was all I needed until the 4th time.

I had a very good oncology nurse who would alternatively inject me with phenytol or morphine to keep the pain at bay.

For me the worst parts were the prep (they had me take a laxative 2 nights prior, then a liquid diet, magnesium citrate and then 2 enemas starting @ 3:30AM prior to each procedure; and the waiting on my back while they CT'd/re-positioned/waited for the physics/programming.

Now, 7 weeks after the procedure my only problem is frequency in the morning and urgency. No accidents and the last week or so have been able to sleep all night long.

Dewayne, Thank you for the update! Always nice to read about each person's personal experience from which we can all benefit... I am planning LDR Brachy asap but have not received a confirmed date as my team would prefer me to have a baseline colonoscopy first. Still hoping before the end of the year... Thanks again and congratulations for getting the first step out of the way towards beating this!!!

My rad-onc required a fresh colonoscopy before my HDR and IMRT.   He wants to know exactly what is going on so he can appropriately apply the radiation to kill the cancer and do as little harm to healthy tissue as possible.

New member-2nd reply - no personal PCa data block prepared yet. GS 3+4, PSA 9.2, lots of % of 22 cores pos, and % pos in each core; that volume thwarted wished-for HDR monotherapy. Hence 50% RT by HDR & 50% IMRT later by others, no HT.

Dewayne, I'm surprised with all the pain regarding removal of the many hollow HDR "catheters" inserted in your prostate and removal of the urinary catheter. In Oct 2007 at age 64 I had HDR by Dr D. Jeffrey Demanes' HDR specializing team in Oakland CA, two yrs before they moved to UCLA after nearly 30 yrs in Oakland. (Surely this is the outfit Michael_T had his done by, per his above reply.)

I looked them up online and saw that the same fondly remembered assistants I had in 2007 and in follow-up visits made the move south with Dr D. -- Lalaine Borja, PA; and Thomas & Alfred, who administer each "fraction" (session) of in-and-out radiation. Simply splendid people who know their business and whose caring for their patient really is evident.

Imaging-guided insertion of HDR catheters was in an OR under spinal; it did the job. It was two straight days back then with the overnight spent with the 18 hollow catheters left installed for the 2nd day's treatment, after which they were pulled w/o anesthetic and w/o pain, same for the urinary catheter. Then try to pass 200ml of urine to verify the ability to, before being allowed to leave -- gotta go before you can go! Same drill the same two weekdays of the next week. As M_T relates, the website confirms: the two-day procedure that shuttled me all over several buildings is now concentrated efficiently into one day per week, avoiding enjoying two hospitalized overnights on one's back as a pincushion between one's legs.

My 2nd week's 2nd morning, Thomas & Alfred checked my hollow needles for any outward slippage, three needed to be pushed back in. That hurt enough to make my face scrunch up. Thomas did the pushing and Alfred made me breathe oxygen. I made sure to drink a lot of water that 2nd week and made my 200ml sample in time for us to leave for Sacramento before traffic got bad.

Despite being a human pincushion, one's perineum really heals fast. Three days after my first week's 2-day session I could only see by mirror where 3 or 4 of the 18 penetrations were, so I took an hour's vigorous bicycle ride on a 41-yr old road race bike with a non-padded Brooks leather bike seat, which bore my 190lbs mostly on my perineum right where the insertion tubes had been -- no problem at all. But the following week, I waited much longer since the whole region down there was feeling the radiation's inflammation. I was private-pay and discovered Dr. Demanes and his HDR method by on my own online research (PCRI's Aug 2007 Insights mag) & chose it over all other methods and clinics.

Coginsac, yes I had the exact same team at UCLA and had to smile when I saw the names you mentioned--I always felt in good hands knowing that everyone followed Dr Demanes around for so long. And the scrunch face was an excellent example of the discomfort felt when re-positioning the needles. My pain was solely related to my back problems.

However, I must say that your perineum healed faster than mine. I did have some issues sitting on certain surfaces for up to a month.

Most important, I hope you're doing well. I'm doing very well, although still in the early innings after stopping HT this spring.

Most of the killing takes awhile.   The radiation damages the cell DNA and the cancer cell is less able to repair itself, stops dividing and eventually dies.   Some cells are so damaged by the high radiation of HDR that they die more quickly, some live longer.   Some may never die, but as long as they are not reproducing they pose no problem.   The prostate cell has one of the longest lifespans of any of the cells in the body.   The PCa cells thus are longer living than other cancer cells.   That is why it will take you anywhere from 18-36 months to each your PSA nadir (low point).